Asymptomatic carotid arterial disease in patients presenting with angiographically proven coronary artery disease.

Atherosclerosis is a systemic and progressive disease process. However, the patterns of disease and the sequence of arterial involvement need further definition. A select group of patients initially presenting with coronary arterial disease was evaluated for evidence of hemodynamically significant carotid arterial disease. Eight per cent of patients were found to have hemodynamically significant carotid arterial disease by the oculopneumoplethysmography (Gee OPG). This low incidence of carotid arterial disease is in contrast to patients who present with carotid arterial disease who are found to have a high incidence of coronary artery disease. This would suggest that either the coronary artery disease develops first or that there is a specific pattern of atherosclerotic vascular disease where patients have coronary artery disease without hemodynamically significant carotid disease. Long-term follow-up on patients initially presenting with coronary arterial disease will help further define this question.

Subclavian steal: a review.

Subclavian steal syndrome is siphoning of blood from the baseovertebral circulation through a reversed flow in a vertebral artery caused by a proximal obstruction, most often an atherosclerotoic lesion, in the subclavian artery. Many patients are asymptomatic; many more probably have undiagnosed disease. Evidence of a possible steal can be detected by unequal upper-extremity pressures and decreased unilateral arm pulse. When symptoms do exist, they may be cerebral, cerebral and brachial, or brachial only. Treatment of choice is a symptomatic patient with confirmed diagnosis by angiography is surgical revascularization. Patient education plays a significant role in reduction of risk factors associated with atherosclerosis and recognition of progression of the disease. Complete vascular workup is warranted from any patient with atherosclerosis.